cancer control fall prevention health consumerism mental fitness mental health nutrition physical fitness weight control wellness center

andropause incontinence kegel exercises men's sexuality prostate health women's sexuality find a pelvic health specialist

addison's disease arthritis diabetes center eating disorders gout center heart disease caregiving

bookstore ebooks wellness store underwear buying guide product catalogs

overview viagra the complications of medication the future vulvar/vaginal disease another viewpoint resources diabetes and sexual health sex and the heart

anatomy physiology anatomical problems diagnosing the problem the hormone theory of treatment vasculogenic theory

home pelvic health women's sexuality overview physiology

women's sexual physiology

by Chris Steidle, MD

In females as in males, there are levels of sexual response that have been divided into four stages. The first stage is excitement. With onset of sexual excitement there are emotional changes as well as vasoconstriction, vaginal lubrication and overall body changes.

In line with the theory that sexual activity is stressful emotionally and physically, the body responds with an increase in heart rate, blood pressure and respiration. In combination with vasoconstriction, this can result in some women developing an uneven skin color during the excitement stage. There is mild vasocongestion within the clitoris that results in swelling to the point in some women that the clitoris noticeably elevates. There may also be slight swelling in the breasts and the nipples may become erect.

Some of these changes occur within seconds. For example, vaginal lubrication, which results from a vascular engorgement of the vaginal wall, occurs sometimes as quickly as 15 seconds after onset of sexual stimulation.

It has also been shown that, due to accumulation of blood, the uterus enlarges slightly and may change its position in the pelvis.

The second stage of sexual response, called the plateau, is actually a continuation of the excitement stage. In fact, the plateau stage happens when vasocongestion reaches its maximum.

In the female, the third stage of sexual response is known as the orgasmic phase, which is both the most intense and short-lived stage. Studies have shown that during this phase, some of the vaginal and perineal muscle fibers undergo contraction.

If women achieve orgasm, it is most often the result of clitoral stimulation. In my experience, most women claim that the two most important organs for achieving orgasm are the brain and the clitoris. This does not mean that a woman has to be smart or well educated to have orgasms but rather that she has to be in the right state of mind. Most women also claim that reaching orgasm is a learned process and, unlike in the male, there may be various levels of orgasms.

Some individuals have suggested a role for the cervix in feeling a “deep” orgasm, however, most women report that bumping of the cervix during intercourse is an unpleasant feeling and can contribute to a cramping sensation after intimacy.

Because they do not become unresponsive to stimulation immediately after orgasm the way a man does, some women are able to continue having orgasms, one right after another. Many women report, however, that after the first orgasm, the clitoral area becomes more sensitive, and that any type of heavy touch can feel painful.

The fourth stage of sexual response is resolution. As its name implies, this is when the body returns back to its non-aroused state. It is thought that, as a result of blood draining from the genital area, the labia turn back to their normal coloration and the vagina returns to its normal size and position. The clitoris also resumes its normal size and consistency, which may happen immediately after orgasm. 

References

1. Take pressure off your sex life. High blood pressure can contribute to sexual problems, as can some treatments for it. Harv Heart Lett, 2004. 15(2): 4.
2. Exercise can spice up your sex life, the American Council on Exercise says. 2005, Medical News Today.
3. Survey of literature. J Sex Med, 2005. 2(2): 279-282.
4. Althof, S.E., et al., Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction. J Sex Med, 2005. 2:793-800.
5. Althof, S.E., et al., Current perspectives on the clinical assessment and diagnosis of female sexual dysfunction and clinical studies of potential therapies: a statement of concern. J Sex Med, 2005. 2 Suppl 3: 146-53.
6. Basson, R., et al., Summary of the recommendations on sexual dysfunctions in women. J Sex Med, 2004. 1(1): 24-34.
7. Basson, R., et al., Assessment and management of women's sexual dysfunctions: problematic desire and arousal. J Sex Med, 2005. 2(3): 291-300.
8. Berman, J., L. Berman, and E. Bumiller, For women only: a revolutionary guide to overcoming sexual dysfunction and reclaiming your sex life. 2001, New York: Henry Holt and Company.
9. Berman, L., J. Berman, and A.B. Schweger, Secrets of the sexually satisfied woman: ten keys to unlocking ultimate pleasure. 2005, New York: Hyperion.
10. Block, J.D. and S.C. Bakos, Sex over 50. 1999, New York: Penguin Putnam Inc.
11. Bohlen, J.G., et al., Heart rate, rate-pressure product, and oxygen uptake during four sexual activities. Arch Intern Med, 1984. 144(9): 1745-8.
12. Bultrini, A., et al., Possible correlation between type 1 diabetes mellitus and female sexual dysfunction: case report and literature review. J Sex Med, 2004. 1(3): 337-40.
13. Cetel, N., Double menopause: what to do when both you and your mate go through hormonal changes together. 2002, Hoboken, NJ: John Wiley & Sons, Inc.
14. Comfort, A., The new joy of sex. 1991, New York: Crown Publishers, Inc.
15. Davis, S.R., et al., Endocrine aspects of female sexual dysfunction. J Sex Med, 2004. 1(1): 82-6.
16. Esposito, K., et al., The metabolic syndrome: a cause of sexual dysfunction in women. Int J Impot Res, 2005. 17(3): 224-6.
17. Farnham, A., Is sex necessary? 2003, Forbes.com.
    http://www.forbes.com/2003/10/08/cz_af_1008health_print.html
18. Gisquet, V., Better sex diet. 2005, Forbes.com.
    http://www.forbes.com/2005/03/17/cx_vg_0317feat_print.html
19. Goldstein, I., Sexual medicine treatment: lifestyle or life quality? The import of language. J Sex Med, 2006. 3(2): 191-3.
20. Goldstein, I., et al., Women's sexual function improves when partners are administered vardenafil for erectile dysfunction: a prospective, randomized, double-blind, placebo-controlled trial. J Sex Med, 2005. 2(6): 819-32.
21. Hakim, L.S. and D.M. Platt, The couple's disease: finding a cure for your "lost" love life. 2002, Delray Beach, FL: DHP Publishers, LLC.
22. Harrar, S. and J. VanTine, Extraordinary togetherness: a woman's guide to love, sex and intimacy. Prevention Health Books for Women. 1999, Emmaus, PA: Rodale Inc.
23. Hatzichristou, D., et al., Clinical evaluation and management strategy for sexual dysfunction in men and women. J Sex Med, 2004. 1(1): 49-57.
24. Hayes, R. and L. Dennerstein, The impact of aging on sexual function and sexual dysfunction in women: a review of population-based studies. J Sex Med, 2005. 2(3): 317-30.
25. Heinemann, L.A., et al., Scale for Quality of Sexual Function (QSF) as an outcome measure for both genders? J Sex Med, 2005. 2(1): 82-95.
26. Hitti, M., Weight loss may help your sex Life, in Medscape Today. 2005.
    http://www.medscape.com/viewarticle/514784
27. Hooper, A., Anne Hooper's Kama Sutra. 1994, London: Dorling Kindersley.
28. Hooper, A., K-I-S-S guide to sex. Keep It Simple Series, ed. J. Williams. 2000, New York: Dorling Kindersley Publishing, Inc.
29. Kaya, C., et al., Sexual function in women with coronary artery disease: a preliminary study. Int J of Impotence Research, 2006, 1-4.
30. Kendall, P., Nuts gaining heart-healthy image, in Nutrition News--Colorado State University Cooperative Extension. 2002.
    http://www.ext.colostate.edu/pubs/columnnn/nn020225.html
31. Laumann, E.O., A. Paik, and R.C. Rosen, Sexual dysfunction in the United States: prevalence and predictors. JAMA, 1999. 281(6): 537-44.
32. Leiblum, S.R. and R.C. Rosen, eds. Principles and practice of sex therapy: update for the 1990s. 2nd ed. 1989, The Guilford Press: New York.
33. Lewis, R.W., et al., Epidemiology/risk factors of sexual dysfunction. J Sex Med, 2004. 1(1): 35-9.
34. Martin, A.C., It's never too late to start: seven steps toward good health, in Topics in Advanced Nursing Practice eJournal. 2002.
    http://www.medscape.com/viewarticle/421471
35. Meston, C. and P. Trapnell, Development and validation of a five-factor sexual satisfaction and distress scale for women: the Sexual Satisfaction Scale for Women (SSS-W). J Sex Med, 2005. 2(1): 66-81.
36. Meston, C.M., Aging and sexuality. West J Med, 1997. 167(4): 285-90.
37. Munarriz, R., et al., A review of the physiology and pharmacology of peripheral (vaginal and clitoral) female genital arousal in the animal model. J Urol, 2003. 170(2 Pt 2): S40-4; discussion S44-5.
38. Nappi, R., et al., Clinical biologic pathophysiologies of women's sexual dysfunction. J Sex Med, 2005. 2(1): 4-25.
39. Oberg, K. and K. Sjogren Fugl-Meyer, On Swedish women's distressing sexual dysfunctions: some concomitant conditions and life satisfaction. J Sex Med, 2005. 2(2): 169-80.
40. Quirk, F., S. Haughie, and T. Symonds, The use of the sexual function questionnaire as a screening tool for women with sexual dysfunction. J Sex Med, 2005. 2(4): 469-77.
41. Salonia, A., et al., Chocolate and women's sexual health: an intriguing correlation. J Sex Med, 2006. 3: 476-482.
42. Seftel, A.D., et al., eds. Sexual dysfunction: male and female. 2004, Mosby: New York. 312.
43. Sheehy, G., Sex and the seasoned woman: pursuing the passionate life. 2006, New York: Random House.
44. Siebert, D., Sexual health: counseling in primary care, in Medscape Today - National Conference for Nurse Practitioners 2001. 2001.
    http://www.medscape.com/viewprogram/852_childindex
45. Somers, S., The sexy years: discover the hormone connection: the secret to fabulous sex, great health, and vitality, for men and women. 2004, New York: Crown Publishers.
46. Tariq, S.H. and J.E. Morley, Maintaining sexual function in older women: physical impediments and psychosocial issues. Women's Health in Primary Care, 2003. 6(3): 157-162.
47. Tikiz, C., et al., Sexual dysfunction in female subjects with fibromyalgia. J Urol, 2005. 174(2): 620-3.
48. Wagner, G., et al., Ethical aspects of sexual medicine. J Sex Med, 2005. 2(2): 163-8.
49. Weijmar Schultz, W., et al., Women's sexual pain and its management. J Sex Med, 2005. 2(3): 301-16.
50. Yassin, A.A., Brain sex--testosterone role in personality evolution; females and males are different? J Sex Med, 2006. 3 Suppl 2: 81-82.
51. Yu, S. and J.W.G. Yarnell, Exercise for the prevention of cardiovascular disease: how vigorous and how often? Cardiovasc Rev Rep, 2004. 25(6): 274-276.

Posted January 2000
Last Updated July 2008

26 South Main Street, PMB #162 . Concord, NH 03301 . Phone: 603 397-0103